AMA Guides® proposal submissions

The AMA Guides to the Evaluation of Permanent Impairment is used by physicians and others who are involved in the impairment rating process.  The AMA is committed to updating the sixth edition of the AMA Guides to ensure most current methodologies are reflected.  To achieve this goal, AMA invites the community to participate in a transparent update process. 

Provide feedback on proposed changes being considered by the AMA Guides Editorial Panel. Formal comment periods provide the public with the opportunity to learn and to express their opinions on anticipated changes. Proposals build upon the prior update to the sixth edition.

Interested parties and organizations who utilize the AMA Guides are invited to comment on the proposed changes to the medicine and impairment ratings. The AMA Guides Editorial Panel will consider all available information and comments prior to adopting these changes as part of AMA Guides Sixth 2024.

Watch for comment period notification emails and announcements through AMA communications and affiliated societies and organizations.

Submit comments to inform the Editorial Panel’s decision making.

In conjunction with their combined expertise across several medical disciplines, the AMA Guides Editorial Panel has adopted a comprehensive set of standards by which content proposals will be accepted.

Interested in submitting a proposal for updates to the AMA Guides? Please review the evidentiary and submission requirements on this page. For additional information, download the AMA Guides process and requirements document (PDF).

All AMA Guides editorial change proposals are reviewed and evaluated by AMA Guides staff and the AMA Guides Editorial Panel. Strict conformance is required for review of an editorial change application. These include:

• Submission of a complete application, including all necessary supporting documents
• Adherence to all deadlines
• Cooperation with requests from AMA Guides staff and/or Editorial Panel members for clarification and information

The AMA Guides Sixth Edition is considered the foundation for proposed updates to the AMA Guides, and future updates to the AMA Guides will build upon the changes that precede them (i.e., AMA Guides Sixth 2022 will build on AMA Guides Sixth 2021).

Proposals that address previous editions of the AMA Guides (e.g., 5^th, 4^th, 3^rd) will not be considered.

General criteria for Guides editorial changes

All editorial change proposals must satisfy each of the following criteria:

• The proposed editorial change is carefully drafted and conforms to the prevailing style of the AMA Guides
• The terminology and the analytical frameworks used in the proposal are consistent with the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF)
• The structure and content of the proposed editorial change ensures that impairment ratings are transparent, clearly stated, and reproducible, to insure physician interrater reliability
• The clinical soundness of the proposed editorial change is demonstrated with the best available evidence except in the case of minor editorial changes (review the evidentiary requirements for additional information)

A proposal for an editorial change must be supported by an evidence-based foundation when possible. When evidence-based medicine is not available, consensus-based medicine developed in a structured Delphi approach may be substituted.

In order of preference, one of the following is required to support each proposed editorial change:

• Evidence-based medicine documented in peer reviewed articles published in medical journals indexed in PubMed, Web of Science, SCOPUS, or Google Scholar that are classified as Level of Evidence I-IV in the Oxford Centre for Evidence Based Medicine Level of Evidence Table (Appendix A)
• Outcomes-based Real-World Evidence (RWE), meaning observational data generated during routine clinical practice and stored in EHRs, medical claims or billing databases, and registries with evidence determined to be of High or Moderate quality using the WHO’s GRADE (Grading or Recommendations, Assessment, Development, and Evaluation) framework (Appendix B)
• Other peer-reviewed sources such as specialty society guidelines developed in accordance with the Institute of Medicine standards¹
• Consensus-based decisions developed in a Delphi process² endorsed or overseen by a relevant stakeholder professional association of society

In some cases, evidence may take the form of data or case law that demonstrates inconsistent application of the AMA Guides or a need for clarification of some element. In these cases, evidence of the need to enhance the AMA Guides may include judicial outcomes such as:

• State-based workers’ compensation impairment rating data that is categorized by CPT code or injury code
• Industrial Commissioner (or similar) data on litigated case outcomes when impairment ratings are an issue
• Judicial opinions or law journal articles that identify a specific issue of wide and inconsistent impairment ratings for similar conditions

• Learn more about AMA Guides Sixth 2022
• Visit the overview page to get details about the initiative to modernize the Guides
• Read about the AMA Guides Editorial Panel selection process
• Register for an upcoming meeting 
• Review and download documents from past meetings  
• See the list of members of the AMA Guides Editorial Panel
• Review the FAQs

¹ Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. https://doi.org/10.17226/13058

² Helmer-Hirschberg, Olaf, Analysis of the Future: The Delphi Method. Santa Monica, CA: RAND Corporation, 1967. https://www.rand.org/pubs/papers/P3558.html

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